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Models of collaborative working

As the 5yfv enters its third year, the recently issued NHSE planning guidance makes it clear that CCGs must actively encourage every practice to be part of the local primary care network which is an interim step to the formation of accountable care systems.

YORLMC is also aware of the significant expectation and pressure on GP Federations to be making important decisions on behalf of practices without necessarily having the infrastructure and mandate to support those decisions.

It is clear from the recent BMA guidance on ACOs that there is:

  • lack of clarity and accountability surrounding the development of ACOs and ICSs so far
  • uncertainty whether the Government will provide the level of NHS funding and investment required for these models to work
  • concern as to how they will secure the future of General Practice

Furthermore, it is currently unclear how these accountable care systems will work alongside the existing GP contract and their emergence has significant implications for General Practice. This is because the basic concept of an ACO is that a group of providers, for example an Acute Trust, a GP federation, Local Authority, social services and voluntary sector will come together to provide a range of services. Collectively they will agree to take responsibility for providing all care for a given population for a defined period of time under a contractual arrangement with a commissioner. The providers collectively will be held accountable for achieving a set of pre-agreed quality outcomes within a given budget or expenditure target. GPs as providers within an ACO model are unique in the sense that they are the only group whose personal assets will be at risk. It is therefore very important that GPs ensure that resource for work within the framework of an ACO is ring fenced to ensure that their practice contract (whether GMS, PMS or APMS) is protected and importantly to ensure that individual livelihood and personal assets are not placed at risk.

YORLMC therefore strongly recommends practices take legal advice before proceeding with any changes to their business model.

YORLMC Ltd cannot provide individual GPs or practices with legal or financial advice. However YORLMC offers all its constituents access to a range of legal services, details of which can be found here

Information and resources for GPs and practices on the four main models of collaborative working in general practice can be found here


April 2018

The voice for NHS GPs and Practice Teams across North Yorkshire, the City of York, Bradford, Airedale, Wharfedale & Craven districts.